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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I White
Pink
Yellow
File
City
Applicant
PERMIT NO. O~ 0
n at bottom)
ADDRESS
frtVl
6~-,
Date Rec' d
8. ?9. 01
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(N ame)
(Phone)
(Address)
BUILDER I' ---r:-:
(Company Name) /~rdtfL./ r;...jL),fi'
(Contact Name) -::;;J;.'!e- J.5ult/I./;:h-'"
(Address) l'itfC? '" I'/'u:i ~
TYPE OF WORK 0 New Construction ODeck OPorch
OAdditlOn OAlteration o Utility Conne
ORe-Siding OLower Level FinIsh 0 Fireplace
CODE: OI.R.C. OLB.C. o Misc.
Type of ConstUlction: I II III IV V A B PROJECT COST IV ALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that 1 have furnished mf( on this applicatIOn which IS to the best of my knowledge true and corrcct I also ccrtlty that I am the owner or iluthorJzed agent for the
Try and that nmstrucl10 WIll conflJrm to all eXlstlOg state and local laws and will proceed lo accordance with submitted plans I am aware that the buildlOg
1St tiluse FurtheI ore, I hereby agree that the City official or a dC~ilgnce may enter upon the prnpelty to perform needed mspectIons
~ - JOS,//7C?g'
Contractor's License No.
Park Support Fee
SAC
#
#
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permit Fee $
Water Meter Size 5/8", I",
Pressure Reducer
Sewer/Water Connection Fee
#
#
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
This Application Becomes Your Building Permit When Approved
Iluildlllg Ufticlal
Date
?-a-7~Ol
Date
$
$
$
$
$
$
$
$
$
.()O
ThiS IS to certity that the requcst in the above application and accompanymg documents is 111 accordance with the City Zoning Ordinance and may proceed as requested ThiS document
when signed by the City Planner conStltutes a temporary Certificate of ZonlOg comphance and allows construCtlon to commence Before occupancy, a Certtficate of Occupancy must be
Issued
Special Conditions, if any
Planning Director
Date
24 hour notice for all inspections (952) 447-9850. fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372